In this episode of "Navigating H.O.P.E.," Dr. Jaime Hope speaks with Dr. Hooman Melamed, a renowned orthopedic spine surgeon specializing in minimally invasive surgery and holistic patient care. Dr. Hooman Melamed shares his unique approach to spine health that goes beyond traditional surgery. Emphasizing the importance of treating the whole person, Dr. Melamed discusses the critical role of lifestyle changes, gut health, and non-invasive treatments in managing and preventing spine issues. He also provides valuable insights into how patients can better advocate for their health, the importance of seeking multiple opinions and understanding the nuances of various spine surgeries.

 

Transcript

00:00:00 [Music] welcome to navigating hope your compass to health empowerment I'm Dr Jamie hope steering you through Health Care overcoming overwhelm personal goals and emergencies we'll navigate the healthcare maze with actionable insights and real world advice unlocking the secrets to a healthier more vibrant life join us to take control of your well-being and make informed decisions for your health and your future stay with us as we unravel the mysteries of medicine wellness and life's unforeseen challenges helping you bypass

00:00:39 the ER with a dose of knowledge stay tuned till the end of the episode with a recap of your actionable insights and a free gift let's chart a course to your well-being together all right everybody welcome back to another excellent episode here I am so excited to introduce my next guest this is Dr hum malamed who is a board certified orthopedic surgeon and he's the founder of the spine Pro he served as director of the scoliosis Center at Cedar cyani Marina del re Hospital from 2013 to 2021 renowned for his expertise

00:01:19 in spinal Health he specializes in minimally invasive spine surgery and non-surgical treatments he is dedicated to improving patient outcomes and preven venting emergency situations as you all know that's near and dear to my heart uh through his Innovative patient centered care he is also a frequent speaker published researcher and advocate for public education Dr melad it is so lovely thank you for being here with us today thank you very much it's a pleasure to be here so let's start with your origin story you don't I I love

00:01:56 what you said that you don't just look at the spine you look at the entire person who is attached to that spine which is such a lovely approach what got you to be passionate about that kind of holistic look at your patients you know when I was in training in my residency one of my mentors always told me never be satisfied with the outcome you're getting and I was like what do you mean no never it's like even if you have a good outcome he's like no you need to think about how you can make it better

00:02:29 so you always have to think about so always you know that always stuck with me and I always thought that about every patient that I saw even if the patient was happy I always wonder could I have done something better what could I have done to make it to make it better and you know you go through training medical school and unfortunately I mean as you know there's not a lot of emphasis on a holistic approach you know it's more um everything is like basically organ there's a heart there's the liver there

00:02:58 is the extremity there's 's your lung there's your kidney it's like I I literally remember in medical school we we're sitting there second year the the the pulmonologist was talking about the long and he said I don't care about the heart that's that's like a secondary we're just here about the lung and and to me I feel like we're isolating but the human body is not isolated we all everything is connected everything works together so I always believe like what can we do to continue improving you know

00:03:29 as I said you went through all of that you you just I feel like you're like a kind of an assembly line like a sheep you're just following what you're told these are the medications you give to the patients when they have this problem you just don't question it you you go on basically and then you know looking at my own health basically um I thought I was pretty healthy but it turns out I wasn't um I started getting to this whole function of medicine at a colleague who opened my eye about 11 years ago

00:03:56 2013 into um like I was basically pre-diabetic I had no idea I was acid reflux and everybody's like telling me that's how it is cholesterol getting up and I thought it was very healthy and I was in very good shape and they're like okay this is getting older but what they showed me my colleague uh that no it's not like that at all it's you are what you eat it a lot of it God health is very critical and God health is very critical to basically everything in your body in your muscular skeleton your

00:04:28 heart lung everything brain everything so we started focusing on my God health and lo on behold that completely changed my life and I started to implement that and I figured you know we surgeons are too always looking at that specific area of the body we're working on and we're not looking at the whole body and I decided that's not good we need to start incorporating the body so I started basically looking into you know focusing really on God Health educating patients on nutrition and most patients are very

00:04:58 deficient in supplement you know no matter how much organic you know vegan whatever you're eating you still unfortunately our soils are in a way that we don't have all the nutrients in our in our soil so what you we are eating is not giving us everything so supplements are needed so we talk about supplements it's really about optimizing the human body right it's optimizing the human body what can I do to optimize you to heal your spine if I can optimize your body I give you a better chance to heal your spine and hopefully avoid

00:05:29 surgery but but if you were to need surgery at least your body is now very very optimized and I believe in this whole non-narcotic approach as I said focusing on God Health you know like fish oil turmeric um Ginger cayenne pepper you know that kind of modalities you know multimodality non-narcotic approach to help uh the patients and that's you know I started doing it about 13 years ago and I started attending classes and seminars on functional medicine and I became very intrigued and I I firsthand saw the massive difference

00:06:03 it's made in my patients not only like recover like without surgery but if they have surgery I mean they they tend to recover very very quickly tell you how refreshing it is to have a conversation with a highly trained surgeon specializing in the spine and you're talking about things like gut health the nutrient deficiency in our soil and even if so whether a patient does or doesn't ultimately end up needing surg you're doing everything you can to optimize their health so either way they're going

00:06:34 to have the best outcome yes so what I tell the patients I said S no surgery is your long-term answer I said surgery is helping you it's helping you to get out of the pain but it doesn't fix the reason why it happened in the first place most of the time it's different than if you're in a car accident you know you get injured I'm talking about stuff that happens wear and tear over time the wear and tear I mean by definition you say wear and tear it's wear and tear it's how you treated your body over

00:07:04 the years so I told the patient I said look whatever we do surgery you don't take care of yourself you know you're going to end up causing more problems later on you know and this surgery is going to fail you know or not as longer lasting so it's really focusing on lifestyle lifestyle their habits a lot of people get in bad habits you know nutrition wise a lot of people think maybe they're healthy but they're not you know I find out a lot of times people are eating uh for example oats we know oats are

00:07:33 very very inflammatory potentially so my job is to educate patients about their lifestyle and uh allow them to understand that you know surgery you know we're so used to quick fixes you know surgery is just okay I'm going to get you out of the pain but really the rest of it is up to you how you want it to turn out you and you really hit on that that's a huge problem that we're facing in medicine people want the Quick Fix they want the magic wand and so they'll go to these charlatans who will say oh yeah I'll do this thing and it'll

00:08:03 magically fix all your problems as opposed to the real people doing the work like you who are saying we also need to look at the underlying processes that led to the problem in the first place otherwise you're going to be in the same place that you were before that is exactly right and yes there are unfortunately some of our colleagues who are quick to recommend surgery right away you need surgery right away and they're very good about convinc in patients and it's you know that oh it's an emergency if you don't do surgery

00:08:35 you're going to be paralyzed you know if you don't do surgery something bad is gonna happen to you you know just a lot of the stuff is honestly is nonsense well and and that's terrifying so you can see how a patient who doesn't know that that would be terrifying so let's talk about that so in the when we were chatting before we hit the record button sometimes those are the best calls you talked about doing your due diligence because just because somebody is has doctor on their name tag doesn't necessarily mean that they have not just

00:09:04 the expertise you have to assume some level of training but you need to know what their practice is like how many patients they're seeing what their experience is so please tell us about how we as healthc care consumers and patients can do our due diligence yeah as we uh were discussing earlier prior um the one of the things unfortunately I mean I hate to say it but you know doctors are supposed to be very revered by a society that we are doing the right thing I mean I would say that's true for

00:09:36 probably a lot of Physicians uh but it's not true for everybody you know unfortunately just like we have bad apples in everything we have police officers look at the George Floyd we know you know lawyers dentists plumbers you know teachers whatever you call it same thing you find in Physicians too that the Physicians sometimes do things for their own nefarious reasons and I I think it's important to understand what is that physician is about and for especially when it comes to spine surgery you want to make sure you're

00:10:09 being treated as an individual person you're not in some assembly line it's not a factory and individualize means you know detailed attention you can sit down you can talk they can talk to you about it not in and out 5 10 minutes you know for example asking you know okay how many patient does the doctor sees in a full day you know I know some of my competitors are seeing 60 70 people a day I mean how do you see it's hard to get personal with each one of those people exactly if you're seeing 60 to 70

00:10:42 people you know a day from 8 AM to like let's say 5:00 P p.m. how do you see 60 70 people I mean think about it and all these new patients you know um you know new patients for me get about we put about a 45 minutes to 60 Minute slot because you know you got to like go over it you know people are worried about spine their spine Health especially if they need surgery you got to talk it takes time you can't go in and out and and also you know one of the things I've learned is in spine surgery to successful outcome the number one rule

00:11:11 is making the correct diagnosis I think a lot of times patients are made incorrect diagnosis they go down the wrong pathway and this stuff takes time like sitting down reviewing the Imaging studies you know if you're seeing 60 70 people a day you cannot sit down and properly pay attention to every patient story in detail and the another question to ask how many surgeries are they doing how many surgeries are they doing uh per week you know my mentor used to say if you're doing six or seven that means you're very busy um and I was

00:11:46 like six or seven but now I understand what he meant because you know to do a spine surgery properly like six or seven like six or seven maybe stretching it to eight that's all you can really do to sit down mentally think about it prepare really pay attention to that on that what I call that individual if they're doing you know 10 15 20 surgeries a week that's a bad sign you know if they're doing eight surgeries a day that's a bad sign um and then also another question I think is asking about um how many what

00:12:18 percentage of their cases are what I call implants based meaning they're putting some kind of an implant in the patient I can tell you most patients do not need implant-based operation so what kind of implants are you talking about are you talking about Hardware are you talking about devices what are we looking at here we're talking about rods and screws okay and you're saying most patients don't need those most patients don't need rods and screws the fusion operation most patients don't don't need

00:12:45 that now look there are exceptions to that for example some of my colleagues who are amazing spine surgeon all they do is they put rods and screws why because they only only only specialize in spinal deformity patients meaning patients who have sever scoliosis kyphosis they're they're hunched over they're crooked they had a prior fail surgery somebody else they do a lot of those that's a different story I'm not talking about that those are uh on the extreme exceptional cases they need the rods and screws that's a spef all the

00:13:16 patients but I'm talking in general patients who have neck pain low back pain you know they need most patients need some kind of a what I call a little rter like a little cleanout operation done you know not multi-level Fusion rods and screws up and down and that what we were talking about beforehand too you brought my attention to something I was not aware that was occurring where surgeons are operating on multiple patients at the same time tell me about that correct that's something nobody even like phams you

00:13:50 know nobody even like they like it doesn't even go to your imagination you know doesn't even go through your head but there are unfortunately some of our surgeons colleagues I should say um who are doing two or three surgeries at the same time simultaneously they're bouncing from room to room to room while somebody else is doing the surgery and they're going room to room and that's how they can do eight or nine surgeries a day right nobody can actually personally do that many surgeries a day you're saying they're using assistants

00:14:16 or other people so the person who you s want thought was doing your surgery might not be the one performing a lot of the action is that right that is correct yes I mean for example you know I remember my dad was having surgery and uh I was there in the preop it was morning before 7:30 I was sitting there with him and I saw the surgeon come in next to me with his patient whatever and then literally there was this nurses station big nurses station in the middle here basically and diagonally across

00:14:48 that so there was this big wall he went to the other side when there was another patient there and they space them so far apart from each other so the two patients don't know that the surgeon is going to be operating on them at the same time and I mean this is so these are the questions to ask you know are they how many surgeries are they doing in a day are they ever doing more than one room at the are they ever doing two room simultaneously you know I mean surgeons say yeah they're going to be

00:15:11 there for the critical part of the surgery but sometimes I tell you surgery does not work like that you're doing something something takes a little bit longer then that patient is all by themselves alone in the other room by somebody else like doing it and it happens and I've seen it repeatedly wow so really to do due diligence patients need to research their physician and they need to come in with a list of questions that is correct that is correct you know if your surgeon is I feel like if you're asking a lot of

00:15:42 reasonable questions about like the steps of the surgery about the posttop recovery I think those are very reasonable questions about the risk of the surgery those are reasonable question if your surgeon is isn't hurry hurry Hasty and uh as I said they're looking to the the shortcut and just just uh cut you off I mean that's not a good sign yeah that's that is very red flaggy okay well I love that you are so turned off by that approach and it's really helped shape the Hands-On personalized surgeon that you are

00:16:17 because there's a certainly patients expect if they're coming into a spine surgeon that they're going to walk in the door and you just can't wait to slice and dice them they they're like this person's gonna want to C me open so say I'm a person right now like maybe I'm a listener in the audience and I have some back problems walk me through what types of problems people come to see you for and this whole approach that you would take to you know to me as a patient with a back problem most uh patients uh end up in my office because

00:16:49 of years of what I alluded to about their lifestyle for example even a simple Act of sleeping you know those who tend to sleep on their stomach or when you sleep on your side but your neck is crooked or your spine is curved like that you know things like that those are if you think about it you're in that position average people sleep you know you're supposed to get eight but let's say you're sleeping six hours seven hours but if you're in in one in the wrong position for six seven hours your spine it now you imagine that you

00:17:21 multiply that every single day every week every year 20 years 30 years like that I what do you think is going to happen to your SP you're going to wear it out so one is sleep second one is your ergonomics you know we all go to school we all went to college we sit but then afterwards once you get into your 20s you know you mid 20s you don't want to spend from 25 to 35 45 55 sitting all day at work that's another thing so that's another one six seven eight hours of people sitting all day sitting generates the highest amount of

00:17:57 intradiscal pressure that's why when when I'm in surgery obviously I'm standing but then when I'm in clinic seeing patients I'm always alternating between standing and sitting all the time in fact a lot of times when I go to patients rooms I don't have a sit down desk that I sit down there I have this uh platform basically raised up and if I need to sit for a second talk to them face to face I do that then I stand up I show him so I'm constantly moving movement is good think about life is about movement you move okay I hate to

00:18:24 use it but you know God when you're dead I mean you don't move right I mean so but you're right though yeah so life is about movement so keep the movement going and then little things uh people don't pay attention you drop you drop something on the floor you bend down you pick it up very quickly those shut bending movements now don't get me wrong we do yoga we do stretching you bend but those are done on a very controlled fashion they're not sudden jerky movement or in your car um you get something the backseat you twist around

00:18:56 the awkwardly these little things that they do on a daily basis or even in the gym working out in the gym like you're always bending down to pick up the weight rather than squatting down you know paying attention to your form especially moms out there um who are doing laundry household chores you know I see that um they're constantly reaching in the crib you know reaching down bending twisting laundry you know running after the kids picking up their toys bending all these little things you know with time it adds up so to answer

00:19:28 your question the first and foremost you want to you want to fix your bad habits and a lot of people don't think about it this is not in their head they're not thinking on a daily basis these are like ingrained in your head and they're as I said they are bad habits you're not even aware you're not even you know conscious about it so talk about the look into into that and then of course nutritionally is is very very big uh gut health is fantastic in terms of being able to heal the body lower the

00:19:55 inflammation so when you have an injury that area is inflamed anytime as you know in the ER when there's any type of injury anywhere even a heart attack it's an injury it's an inflammation the body is uh trying to react to it so if you have a lot of inflammation in your body your body cannot heal your lower back injury the way it should so you want to lower inflammation by focusing on God Health what I call an anti-inflammatory diet unfortunately um again a lot of our uh um patients as you know they're

00:20:28 everybody a lot of people rushing rushing to OIC manaro these medications for weight loss as we know but but these are you know they cause muscle loss they're not just fat loss they you lose muscle and you can't be on it forever and you're not really changing your lifestyle and you're not really changing and when you stop the medication for example you start gaining back but you're gaining a lot of fat and You've Lost That muscle so you end up in worse shape so to me it's all about the lifestyle you got got to fix your you

00:21:00 got to fix your lifestyle and also don't forget the appropriate supplements a lot of people the main supplement that so many people are deficient is vitamin K2 a lot of people are taking now we know educated about vitamin D um but vitamin D3 does not work as well without the K2 the K2 is a very important coenzyme that allows the vitamin D3 to work but most importantly it helps to push all that calcium into your bone the vitamin K2 is a very important regulator and a lot of people are not if in fact I think it's detrimental if

00:21:35 you're taking vitamin D your vitamin D level is high that means you're absorbing a lot of calcium which is fine but that calcium is not going into your bone it's going in all the wrong places into your brain heart kidney lung and all the bad places it's going so vitamin K2 is a very very important supplement that I want to point out that many people are deficient and many patients frankly don't are not aware of it uh that they need to take so you know talk there are other supplements too you know

00:22:01 um cork Comm in which is the active ingredient in turmeric um you know I a good quality fish oil I believe in that um a lot of basically holistic anti-inflammatory and as I said focusing on the god Health the leafy vegetables making sure we get 40 grams of fiber per day those are the things I try to emphasize so to answer your question yeah it's a long it's a long winded answer but I feel like it's not like a one answer oh do this you're GNA be fine you know unfortunately it's doesn't work like that it's a work in progress you

00:22:31 have to change your lifestyle in order to maximize your uh recovery from this uh you know the back thinging that you you came into and I love that because the reality is there is no one quick answer there's no one quick fix or magic wand and to me it's a a red flag if you're seeing a surgeon a physician or any practitioner that's telling you oh yeah you don't have to change your lifestyle just do this one thing and it'll all magically fix so I love that you shared that with us I again can't tell you how much I appreciate uh this

00:23:04 approach so so you help people with the lifestyle thing which is really huge what other modalities if somebody is in pain what other options do you give them so the the lifestyle is very very important and I also want to give credit and point out to our other healthc care colleagues that are acupuncturist or physical therapist or um chiropractors I think they play a very very important role and there are you know some people tell oh I don't believe in chiropractor they manipulate and that's not true you

00:23:36 know the some of the the very well educated and the very good chiropractors they do wonderful they will wonderful I've been to them if they know what they're doing they know how to treat there's no there's no there's nothing wrong with trying chiropractors they can they can help you and then Physical Therapy you know but people have to understand sometimes one modality doesn't work like like for example everybody thinks Physical Therapy but sometimes Physical Therapy doesn't work you have to do acupuncture and

00:24:04 chiropractor so these modalities uh have to be tried um on all the patients I recommend people you know start trying them and the good ones usually people can benefit and usually if you do all of these things that I'm telling you uh combination especially with the lifestyle 90% chance you're not going to need any surgery that's fantastic a surgeon trying to not slice and dice people is the most honest thing I've heard in medicine so long well my motto is the real spine surgeon knows when not to

00:24:35 operate that's my motto on that so to me if you can do that but also you know it's bigger than that because if you were the the patient were to need surgery if you've done all these things that I've just told you if you been doing the therapy you've been you really optimizing your body optimizing your core chunk stability working on that you know guess what you're going to recover from surgery very quickly you're going to bounce back very quickly from the surgery and you're going to have a much

00:25:01 better outcome than you thought you're going to have so these are the people who have been struggling with pain probably for years all the people that say I have back problems Poe posture neck problems so if they do get to the point where you need surgery I love that you recommend versus the old you know cut them wide open and do all this manipulation which takes longer to recover what options do you have in terms of minimal invasive and I believe I saw on your site Ultra minimally invasive yes yes so when you when it

00:25:36 comes down to the surgery you know this is My Philosophy is why you you know you go online and people are freaked out about back surgery spine surgery General why there's a lot of you know bad outcome supposedly out there when you read online you know it really scary when I've actually looked at it's like wow everything is bad you know I'm surprised even patients are coming basically um you know the problem is I tell you uh as I the first thing I said you got to make the correct diagnosis the correct diagnosis is number one in

00:26:04 spine surgery and one of my mentors always told me you got to know the correct diagnosis where is the pain exactly coming from here's the thing just because you see the MRI and the MRI shows all these different things that are wrong doesn't mean I got to go fix everything you know it's not usually like that because as we get older as we get older look um I can tell you once you start MRI people past the age of 30 everybody's going to have some abnormality yes you all you've been in the ER you see CT scan you know you see

00:26:38 like you know patient coming in for something you get a CT scan let's say um of the head whatever or accident you get oh wow the patient has a lot of like degeneration here they may have arthritis but so what they're not symptomatic from it they have no pain from it the most important thing is that I call it natural where wear and tear so there's a natural aging phenomenon that happens that's not painful it's like a tire of a car it wears naturally you don't replace your tire every day you know it wears naturally so the body is

00:27:10 like if you take care of it it n naturally wears it's going to be okay so most important thing is look at the Imaging correlate the Imaging on that patient I mean for example there are patients I've seen like I just operated on somebody couple weeks ago where this if you looked at his MRI my God levels in his lower back were just bad like everything was just bad like it was just the findings if you read the radi Radiology report every level was severe this severe that you know this gross finding here this that but most

00:27:42 importantly again I go back what is the diagnosis treat the patient not the Imaging treat the patient not the Imaging so when I examined the patient carefully you know looked at his symptom his symptoms was coming from only one side and two levels so one side two levels that it so we're talking about the MRI showed five levels left and right so we're talking 10 different areas problematic but I only operated on two of the areas out of the 10 and that was enough to get rid of his symptoms so you the most important thing again treat

00:28:14 the patient not the Imaging treat the patient not the Imaging make the correct diagnosis B two propose the correct surgery sometimes the correct diagnosis is made wrong surgery is recommended and three make sure you do that surgery to Perfection so as I was saying earlier if you basically going back if you do all of these three correct diagnosis propos the correct surgery do that to Perfection that's when you ensure the best outcome in the patient and assuming the patient has done all these optimization stuff now to most patients

00:28:47 like the gentleman I just told you he just need a little r rter so most patients as I was saying I'm not talking where you have severe spinal deformity your lungs are getting crushed you know all that I'm talking about most patients like Garden variety neck pain back pain you know most patients need something very very simple outpatient like a little you go in your rotor router you clean out with a microscope or Ultra minum invasive is where you use an endoscope with a camera basically you make two little holes like

00:29:17 this two little holes the the size of the the tip here you make two holes one of them is your camera here which is going in with the camera you're looking and the other one is a working portal so long um instruments that are skinny and they have a little uh at the tip of it basically you're doing you're doing your work there basically so this allows you know most patients to have obviously it's muscle sparing you're not cutting any muscles you're bypassing all the normal tissue you're getting down to the

00:29:45 Pathology you're doing a RoR rter you're cleaning it all out and it helps many patients avoid the big surgeries like the fusions you know I've been able to save many patients from having been recommended multiple level Fusions for example I had a guy that came from Oregon who was told he needs a three L Fusion done um but I ended up doing one level one side endoscopic little rotor rter clean out yeah it took about two and a half hours but it was worth it because you know he avoided a three level fusion um there was another guy

00:30:16 from Hawaii recently so these endoscopic stuff has been a game changer I'm not trying to my own horn but it was the first one in United States that started doing this what I call this biportal meaning two portal endoscopic approach back in April of 2019 and The more I've done it it's it's been a huge huge game Cher but I also recommend and warn there is no such a thing as a nail and Hammer you can't say every patient needs endoscopic surgery every patient needs microscopic I always believe as I've

00:30:46 said it before um on my other shows that I've been I always say you got to propose the correct operation for the patient even if it's the maximally invasive but if that's the best correct oper for the patient then that's what the patient needs there's some surgeons who say everybody needs milon invasive I mean you can't you can't just do everybody needs this everybody needs that you know I would go through a week and in one week I would do five six different completely different surgeries from each other because you got to do

00:31:16 what's right for every patient whether it's the incision that long like I did one on Wednesday for example incision that long with a 14 level Fusion it was revision revision on a 31 year old but you know what that was the correct surgery for the patient the patient we we did the whole full body optimization before the surgery we got the patient the patient really um went through the surgery with flying colors no narcotics after uh put on the anti-inflammatory diet and that was a correct surgery on

00:31:45 the patient rather than trying to do something you know much far less invasive and that's a huge green flag for me even though you are love doing minimally invasive you're not saying everyone needs that that whole concept when you have is a hammer everything looks like a nail that's a red flag so if the physician that you know any of our listeners are seeing says you know everybody gets the same surgery that that's very worrisome because each person so I love that in in a given week you're doing a different surgery on each

00:32:16 patient based on what they need that's exactly right another one that is out there that people have become really looking to it's artificial disc Replacements you know artificial disc where you're replacing the disc instead of a fusion the neck or the L back and there are unfortunately some surgeons literally I mean their whole website is about artificial disc artificial disc artificial disc everybody's a candidate for artificial disc again that's also very very scary because no that's not true you know um again most patients do

00:32:44 not as I said need implants you know some kind of an implants they can you can get away with roted rter but also when it comes to artificial disc again I think you have to look at the which level if the patient is can is causing the problem a lot of patients are getting two three four level artificial disc but in reality they only need like one level done for example uh maybe two levels not like three or four levels done so if somebody's just telling you all the time artificial disc artificial disc you know that's another thing to

00:33:13 really U be concerned about I love artificial this I think they're they're phenomenon but be very very careful especially the lower back artificial disc because the results even the company admits the results of the lower back artificial disc are not as good as the cervical artificial discs and the one thing that many patients don't know is the lower back artificial is the revision when you have to revision is a complete nightmare it's almost impossible very difficult and and if you don't do well you could have a lifetime

00:33:44 of um you know very very U permanent potential disability if it's got to be done for the right reasons to have the best outcome I've seen countless patients in the ER that have had spine surgeries thinking it would fix the problem but it led to so many Downstream problems they just they regret having it in the first place yes unfortunately I tell the patients that no matter how much pain you're in right now having the wrong spine surgery it can make your pain 100 times worse you wish you were like this than if you had the surgery

00:34:14 absolutely know I love your on your episode when you were on the doctors uh with Dr Travis so everybody by the way if you haven't taken the time please go see that but you talked about ignoring symptoms and window of opportunity to do that so what are things that people should not ignore from the regular all the way up to hey you need to go straight to the ER right now so once in a while I get a patient that I'm when they come I'm like you're going to the ER right now so I think the most important thing you have to look into

00:34:45 when you develop neurologic issues if you're developing numbness in your hand or arms or legs that are getting worse or if you're developing um and or it could be both um or weakness you're losing grip strength you know wait wait a minute my foot doesn't seem to be you know uh moving the way my other foot is moving or I'm dragging it you're my I'm dragging my leg wait a minute I can't I can't squat down like I'm you know I can't like sit anymore like I I don't have the power you know if you start

00:35:18 developing things that are neurologic like strength like you're diminishing strength in an arm or leg part of the body or in your lower extremities um um or start developing Progressive numbness those are huge red flag signs that you need to do not you know you have a small window because those are considered what we call nerve damage that's happening if you ignore that it's like same thing with a chest pain you know if you start having his you know chest pain ah it's just indigestion oh I'm gonna be fine

00:35:48 but by the time the patient comes they have a heart attack they permanent heart damages you know um or stroke you know um you getting a headache you know something bad is going on on you're ignoring it it's the same thing once you get that you need to get evaluated right away and there are patients that when they come in if they have profound neurologic deficits you know they have a lot of weakness the MRI shows severe compression on the nerve and they have a lot of weakness those are the ones you

00:36:14 got to jump on it right away because if you don't that's it once the damage is done it's not coming back it's that's it you're permanently numb or weak in that area of the body so those are the category um of the patients that those are red flag if you anybody listening you have those type of symptoms please do not ignore it go see at your spine surgeon and do not always listen to the pain management or your primary care because they'll tell you oh take some aspirin you know they don't know how to

00:36:45 do proper neurological exam see a very very competent spine surgeon because you may need to have spine surgery and sometimes I tell patients sometimes surgery in very very specific cases as the first line of action is the correct option for the patient you know sometimes telling the patient need surgery right away is the best treatment for the patient because if you don't something bad is going to happen to them and this is why I hate insurance companies because oh uh patient hasn't done six weeks of physical therapy yet

00:37:17 uh it's like hello they don't have time like you know they have 48 hours 24 hours to get to this patient we can't do physical therapy somebody who's like they develop a complete foot drop or a flail foot they they can't squat they have to walk with a walker because they their right knee is buckling from them you know those are the patients you need to jump on them um right away the other thing other than neurologically I always worries me and which is pain at night time when you're sleeping I think pain

00:37:45 at night time that wakes you up always needs to be investigated just God forbid you don't want to miss cancer or God forbid something else so don't that's another thing to look into it um but um so those are the things to look into and those are the things that you should worry you go to a spine surgeon get um Imaging studies done but for the most part most patients again don't need surgery you know again don't treat the Imaging treat the patient like I give you an example I had a patient a 75y old

00:38:18 that came into my office I was the third spine surgeon that she saw the two other spine ins surgeons wanted to do a twole I think one of them wanted to do a twole Fusion one wanted to do two level AR official disc why because she had the MRI showed some pressure on the spinal cord but when I examined the patient clinically she had a completely normal exam in fact all she had for symptom a little bit of a neck stiffness sometimes intermittent next stiff that's all she had so I told her I'm like what are you

00:38:46 doing here go live your life she's like what about the MRI I said well what about the MRI it ain't bothering you it's not causing a problem when it does come back you know for now don't worry about it go live your life and you know what the patients were torn oh I'm GNA get paralyzed I'm gonna get this if I don't do that that's not that's not true that's not true you don't get uh I can tell you most people go on their entire life they don't even know there's something is wrong in their neck because

00:39:13 these are chronic slow changes the body adapts to it and you're not at the risk you think you are yeah and those kind of Scare Tactics are really bothersome because it's for financial gain obviously you make more if you do you know 60 surgeries a week or some nonsense on patients but it's harming them I mean I can think of all my years practicing emergency medicine I have these occasional patients that come in I had this one gentleman in particular he injured his back at work he had been having numbness in his groin and private

00:39:43 area was all of a sudden losing control of his bowel and bladder he'd never had that before this is a young guy in his 30s but he did go through weeks of physical therapy and people not recognizing and he ended up having permanent spinal damage but that's not the majority of cases most of even the back pain I see in the ER don't need emergency surgery they need all of these other lifestyle changes the modalities in seeing a competent surgeon to give them the best recommendation that is exactly right and

00:40:12 that's why you know I used to be in a you know my practice used to be I'm here in La I used to be in a location in marville r with a other group and then I didn't like particularly one um you know I felt some of the my other spine surgeon colleague I felt like too many patients were being told they need surgery right away they need Fusion patients are getting surgery within 24 to 48 hours like you got to do surgery basically being told you have a 48 hour window that if you don't do surgery you're going to have permanent

00:40:43 pain or weakness I mean that is not true that is not true at all you know I can tell you again unless you're having some serious neurologic issue or numbness you're not in danger do not fall for um the fact that you know you're being told you need emergency surgery unless look unless you wake up let's say your foot doesn't work your arm doesn't work like complet is dead and the MRI shows something bad like compression sure you need the surgery yes you need to jump into that surgery but if you if you have

00:41:19 let's say Trace weakness you know you're not even aware you have the weakness meaning you know when I'm examining you your wrist you're like oh okay yeah I guess it's a little bit I didn't realize it you know subtle weaknesses like that you have time you can give it about a week or two two three weeks to see if it's going to improve you don't need to jump into emergency surgery when the patients are being I mean unfortunately I've seen some of my colleagues tell the patient I mean literally this work you

00:41:45 have a 48 hour window that if you don't get surgery you know you have some you're GNA have permanent pain that is not true okay so please again unless you have some Pro Progressive numbness your numbness is getting worse your weakness is getting worse um you know those are the situations okay fine maybe but if you're not in that category do not jump into surgery yeah we want to avoid those predatory people second opinion second and you do see although you are located in California you see a lot of patients

00:42:14 from out State because they did their due diligence and they're trying to find a surgeon that they trust so people will actually drive and fly into to come see you isn't that right yes so you know I have about a third of my patients that come from out of town know out of state you know unfortunately I do a third of my practice also revision surgery a lot of like revision fortunately work that wasn't done I keep doing it yes fixing fixing other prior problem surgeries well I know you have some patients waiting I

00:42:43 just have another question here for you just so people can understand the difference between having a surgery in a hospital versus a surgical center and what are some of those benefits because I think there's a lot of misconceptions out there about that I think the um some some surgeries require Hospital stay because you have to stay in the hospital two three nights you can't stay at a surgery center two or three nights the maximum you can stay in any surgery center for now in the United States is

00:43:10 is one night now there are some Center Surgery centers where they have basically a what I call a postup recovery phase unit meaning you have to leave the surgery center within 24 hours um that's the maxican state as soon as you leave you're going going to this other you know uh room down in the same building or couple buildings where you get to stay there a couple more nights and with nurses you know recovery you know it's sort of like um more of a high-end recovery in this not so much the hospital Surgery

00:43:46 Center but more of a like a think about like plastic surgery sometimes they send their patients to these uh what I call these extended recovery places so those are but in general I think a lot of spine surgery can be done as outpatient they can go to surgery center and the surgery center sometimes you know looking at it I wouldn't say true for all of them but good surgery centers they usually have better nursing just because they're better staff in compared to the hospital and less chance of infection and less chance of infection

00:44:16 you get a little bit better care it's a kind of flying um kind of flying a like business class if you think about it or first class versus the coach if you want to think about it um compared to the hospital because some especially the bigger hospitals sometimes it's difficult you don't get that sometimes the personal attention so surgery centers sometimes provides it a little bit better but it's not always true it's I mean there are some surgery centers out there again they cut Corners to maximize profits I've seen that so

00:44:47 that's that's another thing to think about it's not like all surgery centers are perfect same thing with hospitals some hospitals I would say are way better uh to have your care than the surgery center the question is you know comes down to your surgeon really if you trust your surgeon you have to trust the surgeon who's going to make the right decision to take you to a facility that that surgeon um has the trust that they're going to deliver the best care awesome oh my gosh I love that so everybody stick around after this for

00:45:16 your takeaways and your free gift Dr mamad thank you so much I know you have patients waiting and you're going to go give them personalized care he is in his scrubs he came from the hospital this morning to hop on the podcast to share all of these amazing insights with our listeners thank you for the work that you do any last words yes if I may also you know I want to say first of all anybody listening to me I don't want to claim here that I'm the best I'm perfect no I I have had my own share of

00:45:43 complication you know in fact I remember my mentor told me you know in residency he said if you don't have complication that means either a you're lying or you haven't done enough surgery so complications happens you know but most importantly if you are basically patient who unfortunately didn't have the best outcome most importantly how's your surgeon reacting to it I want to know as soon as I hear I jump on it I have no problem admitting to the patient for example look um for example a simple

00:46:11 bisectomy where you remove the herniated disc you know I've had couple of patients over the recent years where I've done the surgery patient woke up pain same pain guess what I didn't blow them off I got an MRI right away I said I'm sorry there's still a retaining fragment I got to take you back in we take care of it you want to jump into the complication take care of the patients right away and be honest with them be upfront with them and um that's a sign of your your surgeon that is has empathy cares and most importantly

00:46:39 they're transparent they're being honest with you there's no shame in if you have to take a patient back to surgery for something you did not intend to happen if you but don't blow it off and let the patient be in pain and this is what I've seen you know where the patient could have been handled quickly right then and there but the patient was blown off it became a much much bigger problem later on and the patient was this Agony all this time for no reason yeah cuz complications are a normal part of

00:47:06 practicing medicine it's unfortunate sometimes they're inevitable for whatever reason but how your surgeon reacts and how they support you and get you through that process makes all the difference oh so that's yeah so I hope this was informative oh th this was wonderful I know that there are a lot of listeners who have spine problems who are going to have more questions where are the best places that they can find you my website the spine.com www. thespinepro docomo general email is infoinfo thespinepro ccom or phone number General

00:47:47 phone number is 42421 spine area code 42421 spine excellent we'll put all that in the show notes for the people who are driving and listening to this it'll all be there uh available for you again doctor thank you so much this was incred than you very much thank you very much for having me thank you very much thanks so good take care thank you for tuning in to today's episode of the navigating hope podcast Our Guest today was Dr hum melan a renowned Orthopedic spine surgeon specializing in minimally

00:48:15 invasive spine surgery and holistic health approaches let's dive into the five key takeaways from this insightful conversation number one holistic patient centered care Dr melad stressed the importance of treating the whole patient not just the spine his approach includes focusing on lifestyle gut health and anti-inflammatory nutrition to optimize patient outcomes both before and after surgery number two minimally invasive procedures Dr Melman shared his philosophy of always considering a less invasive procedure before recommending a

00:48:52 more invasive surgery he emphasized that surgery should never be a quick fix but it's part of a broader carefully planned recovery process he prefers techniques like the rotor rout or cleanout which helps the need to avoid larger and more invasive surgeries number three gut health in healing Dr melid highlighted the critical role of gut health and an anti-inflammatory diet in healing by improving gut health through nutrition patients can reduce inflammation and support their overall health which

00:49:26 contributes to better surgical outcomes number four red flags in healthc care providers Dr melad warned against assembly line surgeons who see too many patients and perform too many surgeries in a day he advised listeners to be cautious of doctors who rush them into surgery without exploring other options or spend minimal time understanding their unique Health situation and number five evaluating your surgeon one of the most important lessons from Dr melan was the importance of doing your due Ence

00:49:57 when choosing a surgeon he recommends asking key questions about the surgeon's experience the number of surgeries they perform weekly and their approach to personalized care to help you find the right health care provider we are offering a free downloadable red flags and green flags tools for finding and evaluating your health care provider for Optimal Care this tool will guide you through the process of evaluating your Healthcare Providers to ensure you get that Best Care possible click the link

00:50:26 in the show notes and download your copy today remember whe whether you're navigating surgery decisions or looking to optimize your health the key is to stay informed stay proactive and keep navigating your journey with hope thank you for tuning into navigating hope with me Dr Jamie H it has been an honor to navigate the Realms of Health and Wellness with you today remember in the journey toward a healthier life knowledge is your compass if you you en join our time together please share like And subscribe to navigating hope join us

00:51:02 next week where we'll continue to empower your health Journey arming you with the wisdom to navigate life's challenges and keep the emergency room in your rear view mirror [Music]